Healthcare Provider Details

I. General information

NPI: 1750813747
Provider Name (Legal Business Name): RAJITHA KOTA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2017
Last Update Date: 03/07/2023
Certification Date: 10/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2428 SANTA MONICA BLVD STE 200
SANTA MONICA CA
90404-2046
US

IV. Provider business mailing address

5767 W CENTURY BLVD STE 400
LOS ANGELES CA
90045-5631
US

V. Phone/Fax

Practice location:
  • Phone: 310-998-5868
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA169279
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: